Cancer

Determination of the types and the stages of ovarian cancer require a thorough check-up and diagnosis to initiate the necessary line of treatment accordingly. Dr.Amish V. Dalal, a renowned Surgical Oncologist, assesses the condition of his patients and recommends treatment.

Staging of Ovarian Cancer

Staging refers to the diagnostic process that assesses the extent to which the cancer has spread from the location of its origin. This aids oncologists to decide on the necessity for a surgery as treatment. Accurate staging is important to arrest malignant tumour from spreading. Once the stage of the cancer has been diagnosed, it remains constant irrespective of the recurrence of cancer. The stage remains unchanged even if the cancer metastasises or spreads to new locations in the body.

As a part of diagnosis and determination of the type and stage of cancer, tissues samples are collected from different parts of the abdomen and the pelvis for examination under a microscope. This procedure also helps oncologists to assess whether the cancer is benign and does not require treatment, or is malignant. In case the cancer is malignant, a surgery is usually considered as treatment. For ovarian cancer, oncologists follow a 1 to 4 staging system. DoctorAmish Dalal analyses the stage of the ovarian cancer basis the tissue collected and recommends the next course of treatment accordingly.

The most recognised staging system is the TNM (Tumour, Nodes and Metastasis). It serves as the basis of the International Federation of Gynecology and Obstetrics or FIGO staging system.

To break it down further, TNM stands for:

Post-surgery results for the prognosis of the extent and size of the primary tumour, wherein ‘T’ stands for ‘tumour’

Location and number of metastasis to the adjoining lymph nodes, wherein ‘N’ stands for ‘nodes’

Presence or absence of distant metastasis, that is, metastasis to other parts of the body, wherein ‘M’ stands for ‘metastasis’

Amish Dalal reviews the medical condition of his patients to decide on the stage of the disease.

Types of Ovarian Cancer

There are different types of ovarian cancer that are classified basis the cell from which the disease has originated. These are:

Common epithelial tumours

This refer to the cells lining the outer surface of ovaries. It usually occurs in postmenopausal women. Most tumours that develop on the surface of ovaries are usually benign and do not require treatment. It needs frequent diagnosis of the tumour for seasoned oncologists like Dr. Amish Dalal to decide on the stage and line of treatment. Some epithelial tumours, referred to as tumours of low malignant potential (LMP tumours) or borderline tumours, may not be clearly identifiable as cancerous. This further emphasises on the importance of frequent evaluation for early diagnosis of the disease.

Germ cell tumours

The origin of germ cell tumours lies in the cells that produce eggs or ova. They can be benign or may need further treatment. The common germ cell tumours are dysgerminomas, teratomas and endodermal sinus tumours. It usually develops among teenagers and women in their twenties.

Stromal tumours

This develops in the connective tissue cells that hold the ovaries together and those that produce female hormones, progesterone and oestrogen. Some of the most common types of stromal tumours are Sertoli-Leydig cell tumours and granulosa-theca tumours. It is a rare form of cancer that manifests itself in the Stage I of the disease, which may not always hold true for other types of cancer.

Small cell ovarian carcinoma (SCCO)

It is a rare cancer type that is usually malignant by nature and affects women in their mid-twenties. Some of the common types are neuro-endocrine, pulmonary and hypercalcemic.

Patients diagnosed with malignant tumours can book an appointment with Amish Dalal at Jaslok Hospital, Breach Candy Hospital, Bhatia General Hospital, Saifee Hospital or Parsee General Hospital.

“Cancer is not a concentration camp, but it shares the quality of annihilation: it negates the possibility of life outside and beyond itself; it subsumes all living.”

– Siddhartha Mukherjee, The Emperor of All Maladies: A Biography of Cancer

Siddhartha Mukherjee refers to cancer as being the emperor of all maladies. Not without a reason. Ovarian cancer happens to be the most malignant form of gynaecological cancers, and the fifth leading cause of cancer-related deaths amongst women.

Three of the main determinants of ovarian cancer are age, family history and genetics. However, the disease does not restrict itself only within families sharing a past history. Women, especially post-menopause and those with a family history of breast and cervical cancer are advised to undertake screening tests for ovarian cancer. Another factor that plays a major role in ovarian cancer is the BRCA1/2 gene that accounts for 10% of all ovarian cancer cases. Over the past 30 years, Dr. Amish Dalal has successfully diagnosed patients with ovarian cancer.

The following pose as common risk factors:

A personal history of breast cancer before 45 years of age

Personal or family history of cancer in the fallopian tube, ovarian canvcer, or primary peritoneal cancer (a rare form of cancer closely related to epithelial ovarian cancer) among first or second degree relative(s), that is, sister, mother and/or grandmother

Family or personal history of the BRCA1/2gene that exists amongst approximately 10% of all ovarian cancer cases, which can be inherited

A history of breast cancer in a male relative (cancer occurring in the chest region amongst males is also termed as ‘breast cancer’). Studies show that a history ofbreast cancer in a first or second degree male relative (father, brother or uncle) increases the risk of cancer among the female members of the family as well

Personal or family history of hereditary non-polyposis colorectal cancer in a first or second degree relative. Hereditary non-polyposis colorectal cancer is a genetic condition that increases the risk of colon cancer, as well as cancers in other parts of the human body like the stomach, small intestine, ovaries, brain, urinary tract and the skin.

Disregarding, neglecting or not being able to recognize the symptoms of ovarian cancer can have significant consequences. However, patients who have a certain level of awareness and who undergo regular health check-ups have a higher chance of detecting the disease early enough to get cured. If the disease spreads to other organs in the body, it makes its management challenging. Dr. Amish V Dalal, a Surgical Oncologist, is highly acclaimed and sought after for his advice and treatment.

Common Symptoms of Ovarian Cancer

The common symptoms of ovarian cancer may generally be misleading and can be mistaken as the side-effects of indigestion, associated with:

Bloating

Abdominal pain

Feeling full and/or

The urgency to urinate more often

If you or someone you know experiences any of these symptoms make sure to get them diagnosed by an expert like Amish Dalal.

Early Diagnosis and Prevention

Awareness about the symptoms of ovarian cancer and promptly diagnosing them can help in preventing the disease from spreading to other parts of the body. According to the American Cancer Society, approximately 20% of ovarian cancers are diagnosed at an early stage. The Society states that an early detection of the disease at a localised stage enhances the longevity of about 94% of patients by more than 5 years.

Two major diagnostic tests are usually prescribed for the detection of ovarian cancer – transvaginal ultrasound (TVUS) and CA-125 (Cancer Antigen-125) blood test. After understanding the patient’s history and evaluating the present medical condition, Dr. Dalal advises patients on the necessary tests to be conducted.

TVUS involves inserting an ultrasound wand inside the vagina to get a close view at the uterus, ovaries and fallopian tubes. This painless screening test usually aids in detecting the tumour in the ovary and it can estimate whether the growth is cancerous or benign. A high level of CA-125 in the blood stream indicates the existence of ovarian cancer. A reduction in the CA-125 level in the blood shows that the medication is taking effect. When Amish Dalalreviews the symptoms of his patients, he decides on the necessary screening tests accordingly.

Patients diagnosed with cancer can book an appointment with Amish Dalal at Jaslok Hospital, Breach Candy Hospital, Bhatia General Hospital, Saifee Hospital or Parsee General Hospital.

Ovarian cancer is more prevalent among women who have reached the age of menopause. Women who have close relatives with the disease are also at a greater risk of being diagnosed with it. Ovarian cancer occurs when normal cells in the ovary turn abnormal and, in advanced stages, spread to other parts of the body.

The initial symptom of ovarian cancer is increase in the size of the abdomen and bloating, though these symptoms do not necessarily always indicate at cancer in the ovary. The required medical tests, under the instructions of an experienced health professional, have to be conducted to diagnose the reason for the abdominal anomalies. An imaging test like CT scan, ultrasound or both, and a blood test, known as CA-125, are usually recommended to diagnose the cause of the symptoms. If the tests point towards ovarian cancer, the stage of the disease needs to be determined to decide on the next line of treatment. For instance, when patients approach Dr. Amish Vasant Dalal, he closely examines their medical tests and advises surgery, if required.

It helps a patient when she is conscious and well aware about her medical condition. Here is a list of some of the essential questions that a patient needs to ask doctors before starting the treatment for ovarian cancer:

What type of ovarian cancer do I have?

Ovarian cancer be broadly categorised on the basis of their origin of growth – in the cells that produce eggs in the ovary, along the inner wall of the organ (epithelium), or in the cells that produce hormones. Being actively involved in the diagnosis process is a step towards staying updated regarding one’s own medical condition. Doctor Amish Dalal, with his expertise in oncology, can guide patients on the type of ovarian cancer that they have been diagnosed with.

What is the treatment that I need?

Chemotherapy is usually the recommended treatment. However, the healthcare professional may recommend that the patient explore other treatment methods like a surgery as a more effective treatment for the disease. In such cases, the patient needs to approach an oncologist for an opinion on the necessity of a surgery. Dr. Amish V Dalal, an accomplished Surgical Oncologist with 30 years of experience in the field, analyses the medical condition of his patients and recommends a surgery, if needed.

How do you administer chemotherapy?

There are usually two methods for administering chemotherapy – intraperitoneal and intravenous. Intraperitoneal chemo refers to injecting the drug directly into the abdominal cavity through a thin catheter, while for intravenous chemo, the drug is injected into veins. The chemotherapist assesses the suitability of these methods to each patient and administers the treatment accordingly.

What surgery is suitable for me?

A debulking surgery aims for a cytoreductive effort, that is, the aim to remove the cancerous tumour entirely, so there is no remaining residue. In certain instances when the tumour may have spread to the adjoining parts of the body, there may be a big tumour along with the presence of small tumours in the abdominal cavity. However, debulking may not always be a viable option for every patient. Hence, oncologists decide on the necessary course of treatment according to their discretion that is based on the patient’s medical condition. Amish Dalal reviews the condition of his patients and assesses the nature of the surgery to be undertaken.

What are the different procedures of surgery and the one that is suitable for me?

Patients also need to have a detailed discussion with their oncologist regarding the method of surgery best suited for them – open method, laproscopy and robotic surgery. Dr. Amish Dalal is experienced in all these methods of surgery. Patients can approach their oncologists to understand the dynamics of each of these methods of surgery, the suitability of each of these for them and reach a mutual decision.

Patients diagnosed with malignant tumours can book an appointment with Amish Dalal at Jaslok Hospital, Breach Candy Hospital, Bhatia General Hospital, Saifee Hospital or Parsee General Hospital.

Radiotherapy, or radiation therapy, is often used in conjunction with other lines of treatment such as surgery, and chemotherapy in patients detected with malignancy. So, patients who are advised radiotherapy are treated under a multidisciplinary team of doctors and medical professionals. Dr. Amish Dalal reviews the patient’s medical condition and, if necessary, recommends radiotherapy. radiotherapy sessions last about 15 to 30 minutes and have been known to bring about relief in up to 40% of patients followed by alleviation of pain in the bones. It is also known to control other common symptoms of the disease, like bleeding from the lungs and the bladder.

Radiotherapy costs about 6% of each health dollar spent fighting cancer. As pointed out by Doctor Amish Dalal, the effectiveness of radiotherapy depends on the location in the body that has been affected. Cancers affecting the skin, neck, head, breast, prostrate, thyroid, anus, and cervix are believed to respond well with radiotherapy. Dr. Dalal, along with his team of medical practitioners, assesses the affected area and recommends the next course of treatment accordingly.

Doctor Amish Dalal and the multidisciplinary team take into account the lifetime dose limits of radiation that should be administered to every individual. There is a limit to the amount of radiation that can be administered to the area of malignancy, while attempting to shield the unaffected zones. Radiotherapy may not be advised in instances where either the patient is suffering from a different type of cancer or has already received the lifetime allowable dose of radiation.

Dr. Amish Dalal asserts that its low cost makes it a viable option for most of the eligible patients. Dr. Amish, goes on to opine that Radiotherapy serves as an important cog in the wheel of the comprehensive management of the disease.

Here are some of the benefits of radiotherapy according to Doctor Amish Dalal, that make it a worthy contender in the treatment for cancer:

Radiotherapy enables targeting the specific area that has been diagnosed with cancer with a certain level of precision, unlike chemotherapy. As explained by the National Cancer Institute, this makes it possible for the cancer cells to be reduced in number, with minimal damage to the surrounding tissues and organs. Dr. Dalal refers patients to a radiotherapy lab after a thorough check-up of the affected area, and assessing the modality of the treatment.

As radiotherapy does not require the patient to be hospitalised, it reduces the cost of the overall treatment. After radiotherapy, the patient can return to his normal lifestyle immediately.

A combination of radiotherapy and chemotherapy reduces the chances of an early recurrence after surgery. Depending on several factors, radiotherapy is also known to shrink tumours, making them potentially inoperable and not warranting surgery. Dr. Amish V Dalal, a leading Surgical Oncologist with an experience of over 30 years, and his team of medical experts have successfully treated countless patients who have received radiotherapy.

Patients diagnosed with cancer can book an appointment with Amish Dalal at Jaslok Hospital, Breach Candy Hospital, Bhatia General Hospital, Saifee Hospital or Parsee General Hospital.

Surgical oncology, as a specialised method of surgery for cancerous tumours, has evolved since the last three decades. Surgery is usually considered to be the most effective method of treatment of cancer. Ephraim McDowell undertook the first reported cancer surgery for ovarian tumour in 1809.

Who is a Surgical Oncologist?

Surgical oncologists specialise in the treatment of malignant neoplastic disease, with in-depth knowledge and expertise to perform the standard and advanced procedures as considered necessary for each patient. An accomplished surgical oncologist not only possesses the ability to diagnose tumours but has adequate knowledge in haematology, pathology, medical oncology and radiation oncology. Surgical oncologists, when considered necessary, refer patients to radio therapists for tests, and ensure appropriate multimodality care. This, in turn, aids in undertaking the accurate line of treatment. Over the past 30 years, Dr. Amish Dalal has successfully diagnosed and treated patients with cancer.

Multidisciplinary Management of Cancer

As discussed above, surgical oncologists referring patients to radio oncologists denote the multidisciplinary management of the treatment. Solid malignancies can be treated successfully simply through therapy alone, when detected during the early stage. However, in addition to standard therapy treatment, surgeries are indicated in advanced stages. This supports the argument that surgery is usually opted as an effective method in the treatment of cancer. Dr Amish V Dalal, a Surgical Oncologist, is renowned for his expertise in conducting cancer surgeries.

An Overview of the Role of a Surgical Oncologist

The role of a surgical oncologist primarily spans over four areas:

Exploring the scope of effective treatment solely through therapy, especially in early stages, which may avoid the need of a resection (removal of a tumour through surgery)

Excision of malignant tumours

Removal of malignant lymph nodes at the time of surgery

Treating any cases of recurrence of the disease

A study of the complete history of a patient and physical examination during consultation helps the surgical oncologist to assess the medical condition of the patient and decide upon the line of treatment, that is, whether it is treatable through therapy alone, or it warrants resection. If managed through surgery, a combination of post-surgical treatment including radiotherapy and chemotherapy is generally followed.

An acclaimed surgical oncologist is adept with removing cancer tumours and a portion of surrounding tissue, which may not look infected macroscopically but carries the risk of being malignant, which may be detected microscopically. This procedure usually helps in preventing the disease from spreading to other parts of the body and recurring in the future. In the case of borderline resection, the oncologist conducts a surgery, referred to as ‘Debulking’, to remove as much tumour as is considered possible and follow-up with post-surgery therapy to relieve pain. Amish Dalal, a renowned Oncologist, is proficient with conducting gynaecological oncological surgeries, after analysing the nature, location and stage of tumours.

Methods of Surgery

The method of surgery followed by the surgical oncologist depends on the location and stage of the disease, as well as other factors including health condition and fitness of the patient. Doctor Amish Dalal has the necessary expertise in the following methods of cancer surgery:

Open Surgery

Laparoscopy, depending on the patient’s medical condition and financial resources

Robotic Surgery

Doctor Amish Dalal, with his knowledge in his field of specialisation and along with the state-of-the-art surgical equipments, is able to provide world-class management of the disease. Dr. Amish Vasant Dalal also conducts Robotic Surgery – one of the most advanced surgical methods in the field of medical science. The surgery provides the surgeon the advantage of 10x magnification along with a 3D view while operating. This method of surgery not only reduces pain considerably but also ensures speedy recovery as compared to Open Surgery.

Role Of A Surgical Oncologist Post-Surgery: Reconstructive Surgery

Many patients, in cases where oncological surgery may have had a disfigurative impact on body aesthetics, may opt for a reconstructive surgery. Reconstruction that follows close to the heels of the oncological surgery is known as ‘Immediate Reconstruction’. Reconstructive Surgery can also be undertaken a few weeks or months later, and is referred to as ‘Delayed Reconstruction’. In such cases, the patient is referred to a plastic surgeon for ‘Oncoplastic Surgery’.

Breast cancer can sometimes be diagnosed after the detection of usual symptoms because, in the early stage, the symptoms often do not become apparent or are not felt. Therefore, a daily self-examination often proves to be helpful in detected probable symptoms as early as possible. The moment you feel anything unusual like redness, change in size and shape of your breasts, or an unusual growth like a lump in your breasts or armpits which does not feel like a part of your breast tissue, immediately visit an oncologist for a check-up. Dr. Amish Vasant Dalal, a leading oncologist in Mumbai, an acclaimed authority on the subject and treatment of breast cancer.

After talking to patients and understanding their problems, Doctor Amish Dalal conducts medical examinations in order to carry out the necessary evaluation. Some of the common tests for diagnosing breast cancer are:

Breast Ultrasound (Sonography)

Better known a Sonography, this method uses sound waves to detect whether there are any changes in the breast tissue, those that can be felt but not visible on Mammogram. An ultrasound test also helps in differentiating between solid masses and cysts that are filled with fluid. Dr. Amish conducts the Sonography using his infallible judgement. Dr Amish V Dalal, is a veteran Surgical Oncologist and Gynaecologist with an experience of over 30 years in the field

Mammograms

Mammograms are best described as the X-ray of the breasts. This is an effective method to diagnose changes in the breast tissue in cases where women show no visible symptoms of a breast anomaly. This medical examination involves taking two views of each breast, with focus on the suspected region. Amish Dalal conducts Mammograms at Jaslok Hospital, Breach Candy Hospital, Saifee Hospital, Bhatia General Hospital, and Parsee General Hospital.

MRI (Magnetic Resonance Imaging) of breasts

An experienced oncologist like Amish Dalal is highly sought after for his expertise.He conducts MRI tests at the hospitals that he works with. As opposed to Mammograms that use X-rays, MRIs use radio waves and strong magnets. These waves enter the body and bounce-off, forming a pattern that is determined by body characteristics and the nature of disease. The pattern is transmitted by the computer into a picture, which is reflected on a screen. While conducting an MRI for detecting breast cancer, a contrast liquid known as gadolinium needs to be introduced into a vein before or while scanning for improving the quality of detection. Dr. Amish Dalalstudies the MRI and advises the next course of action.

Under the guidance and expertise of Dr. Amish Dalal, patients can rest assured that they receive the best care and treatment possible. He is available at the above mentioned leading Mumbai hospitals only by prior appointment.

Cancers are of two types – benign and malignant. Benign cancers do not require any further treatment. For malignant cancers, the results of medical tests determine the next course of treatment. The treatment may be chemotherapy, or surgery, or a combination of both, depending on the size and location of the tumour, or how patients respond to their treatment.

Surgical oncologists may recommend a surgery for gynaecologic cancer as a parallel treatment with chemotherapy. For patients who are already undergoing chemotherapy and their medical oncologists feel the need for a surgery for better treatment, they suggest their patients to seek the opinion of a surgical oncologist. A gynaecological surgery may also be succeeded by chemotherapy. Otherwise, a surgery may be deemed to be the best available treatment for removal of the cancerous tumour. Dr. Amish V Dalal, an expert Surgical Oncologist with over 30 years of experience in the field, advises his patients regarding the necessity of a gynaecological surgery after assessing the medical tests.

GYNAECOLOGICAL SURGERIES

Gynaecological cancer usually involves the removal of the tumour of the ovaries, uterus and cervix. However, different types of surgeries are undertaken depending on the location of the cancerous growth. Dr. Amish Dalal evaluates the medical conditions of his patients before recommending the suitable surgery. Here are some of the gynaecological surgeries:

Debulking surgery: Removal of as much tumour as possible, while the remaining a cancerous growth is treated through chemotherapy. This is usually recommended when the surgical removal of the entire tumour is not advisable.

Staging surgery: This includes the removal of tissues from different parts of the abdomen or pelvis as a sample to evaluate the stage of cancer. This assists oncologists to assess the next line of treatment.

Unilateral salpingo-oophorectomy: Surgery for the removal of one fallopian tube and one ovary is known as Unilateral Salpingo-oophorectomy.

Bilateral salpingo-oophorectomy: This is the surgery for the removal of both the ovaries and both the fallopian tubes.

Radical hysterectomy: This surgery refers to the removal of parts of the vagina, uterus, the ovaries or the fallopian tubes. Lymph nodes may also be removed on the discretion of the surgical oncologist.

Total hysterectomy: Removal of the cancer, including the cervix, is known as ‘total hysterectomy’.

METHODS OF GYNAECOLOGICAL SURGERY

Dr. Amish Vasant Dalal is accomplished in conducting all the three methods of surgeries that are available in India. These methods are:

Open Surgery: This conventional method of gynaecological surgery, also referred to as laparotomy, follows the procedure of making an incision to reach the organ with the tumour. The surgical oncologists insert the necessary medical instruments for conducting the surgery in this invasive surgery. The incision made may be horizontal or vertical, as it is considered befitting by the surgeon.

Laparoscopy: This minimally or partially invasive surgery is undertaken through smaller incisions, as compared to the Open Surgery. The surgical instruments, and a camera is inserted through the incision to take images of the inside of the human body. These images are reflected onto the video monitor, which the surgeon closely follows to conduct the surgery with precision.

Robotic Surgery: The robotic-assisted ‘Da Vinci Surgery’ is an advanced minimal invasive surgery that features video monitors with the ability to reflect 3D high-definition images. Wristed instruments can rotate and bend as and when the surgeon needs enabling a clear view of organs. This allows surgeons to conduct the surgery with enhanced vision and dexterity. The surgery induces less pain and surgical wounds, leading to faster recovery.

Amish Dalal, being a highly experienced Gynaecologist, discusses with his patients these surgical methods and mutually decides on the method that will be undertaken.

Patients diagnosed with gynaecological cancer can book an appointment with Amish Dalal at Jaslok Hospital, Breach Candy Hospital, Bhatia General Hospital, Saifee Hospital or Parsee General Hospital.

Cancers are of two types – benign and malignant. Benign cancers do not require any further treatment. For malignant cancers, the results of medical tests determine the next course of treatment. The treatment may be chemotherapy, or surgery, or a combination of both, depending on the size and location of the tumour, or how patients respond to their treatment.

Surgical oncologists may recommend a surgery for gynaecologic cancer as a parallel treatment with chemotherapy. For patients who are already undergoing chemotherapy and their medical oncologists feel the need for a surgery for better treatment, they suggest their patients to seek the opinion of a surgical oncologist. A gynaecological surgery may also be succeeded by chemotherapy. Otherwise, a surgery may be deemed to be the best available treatment for removal of the cancerous tumour. Dr. Amish V Dalal, an expert Surgical Oncologist with over 30 years of experience in the field, advises his patients regarding the necessity of a gynaecological surgery after assessing the medical tests.

GYNAECOLOGICAL SURGERIES

Gynaecological cancer usually involves the removal of the tumour of the ovaries, uterus and cervix. However, different types of surgeries are undertaken depending on the location of the cancerous growth. Dr. Amish Dalal evaluates the medical conditions of his patients before recommending the suitable surgery. Here are some of the gynaecological surgeries:

Debulking surgery: Removal of as much tumour as possible, while the remaining a cancerous growth is treated through chemotherapy. This is usually recommended when the surgical removal of the entire tumour is not advisable.

Staging surgery: This includes the removal of tissues from different parts of the abdomen or pelvis as a sample to evaluate the stage of cancer. This assists oncologists to assess the next line of treatment.

Unilateral salpingo-oophorectomy: Surgery for the removal of one fallopian tube and one ovary is known as Unilateral Salpingo-oophorectomy.

Bilateral salpingo-oophorectomy: This is the surgery for the removal of both the ovaries and both the fallopian tubes.

Radical hysterectomy: This surgery refers to the removal of parts of the vagina, uterus, the ovaries or the fallopian tubes. Lymph nodes may also be removed on the discretion of the surgical oncologist.

Total hysterectomy: Removal of the cancer, including the cervix, is known as ‘total hysterectomy’.

METHODS OF GYNAECOLOGICAL SURGERY

Dr. Amish Vasant Dalal is accomplished in conducting all the three methods of surgeries that are available in India. These methods are:

Open Surgery: This conventional method of gynaecological surgery, also referred to as laparotomy, follows the procedure of making an incision to reach the organ with the tumour. The surgical oncologists insert the necessary medical instruments for conducting the surgery in this invasive surgery. The incision made may be horizontal or vertical, as it is considered befitting by the surgeon.

Laparoscopy: This minimally or partially invasive surgery is undertaken through smaller incisions, as compared to the Open Surgery. The surgical instruments, and a camera is inserted through the incision to take images of the inside of the human body. These images are reflected onto the video monitor, which the surgeon closely follows to conduct the surgery with precision.

Robotic Surgery: The robotic-assisted ‘Da Vinci Surgery’ is an advanced minimal invasive surgery that features video monitors with the ability to reflect 3D high-definition images. Wristed instruments can rotate and bend as and when the surgeon needs enabling a clear view of organs. This allows surgeons to conduct the surgery with enhanced vision and dexterity. The surgery induces less pain and surgical wounds, leading to faster recovery.

Amish Dalal, being a highly experienced Gynaecologist, discusses with his patients these surgical methods and mutually decides on the method that will be undertaken.

Patients diagnosed with gynaecological cancer can book an appointment with Amish Dalal at Jaslok Hospital, Breach Candy Hospital, Bhatia General Hospital, Saifee Hospital or Parsee General Hospital.

Breast cancer, among women, is steadily on the rise since the last 10 years. It is the most common cancer among women, far ahead of cervical cancer. Unlike other cancers that usually affect women after the age of 50, breast cancer can be diagnosed among younger women as well.

A sharp pain in the breasts, accompanied with some tenderness, often becomes a cause for concern, especially if it is a prolonged experience. Though a lump or mass in the breast is associated with breast cancer in a vast majority of women in their early 20s to 50s, it is usually a benign tumour in a majority of cases. Besides, breast lumps may also be the cause of hormonal changes among young adolescent women.

A tumour can be either benign or malignant. A benign tumour is usually not malignant tumour, which indicates at cancer. Unlike malignant cancer, it does not invade surrounding tissues or other parts of the body. Benign tumour usually does not require further treatment unless they affect nerves or blood vessels. When tests indicate at malignancy Dr. Amish V Dalal, an accomplished Surgical Oncologist, may recommend a surgery, if required.

BENIGN BREAST TUMOUR

Types of benign breast tumours

The major types of benign tumour can be classified as:

Fibroepithelial breast tumours

The unusual masses are a combination of various glandular elements and stroma (tissues).

Cysts and abscesses

Cysts are sacs containing fluid that may develop as result of hormonal changes associated with menstruation. An abscess is infection that may occur in women who are breastfeeding.

Calcification

When calcium salts get accumulated in a breast tissue, referred to as calcification in medical terms, may indicate at a potential breast cancer. While most calcifications are caused due to normal biological processes, certain microcalcifications may be a result of breast carcinoma – a condition that develops from epithelial tissues of the breast.

Other types of breast lesions

Some breast lumps or masses may develop after a surgery, as a result of natural biological changes like pregnancy, among other reasons.

Symptoms indicating the presence of a benign breast tumour

Common symptoms of non-cancerous tumour or ‘fibroadenoma’ are:

Infection in breasts

Damaged tissue or fat necrosis, which appears like a cancerous lump but cannot be distinguished unless a biopsy is conducted

Fibrocystic breast disease

When tests indicate at malignancy, the medical oncologist usually recommends a Surgical Oncologist. Dr. Amish Dalal examines the medical condition of the patient and determines the line of treatment.

MALIGNANT BREAST CANCER

Types of Malignant Breast Cancer

Breast cancer can be broadly categorised into two types:

Invasive breast cancer

When nearby tissues are invaded by cancerous cells that break out from the inner surfaces of the ducts or lobules, it is referred to as ‘invasive breast cancer’. These abnormal cells may travel through the lymphatic system or bloodstream, spread to the surrounding lymph nodes and gradually to other organs like lungs, liver or bones in the early or advanced stages of the disease.

Non-invasive breast cancer

Here, the cancerous cell does not break out but remains restricted in its place of origin. When the cell originates in lobules, it is known as ‘lobular carcinoma in situ’ in medical terms, while it is referred to as ‘ductal carcinoma in situ’ when it remains inside milk ducts. The phase ‘in situ’ means ‘in its original place’. This type of breast cancer can eventually spread to the surrounding tissues and organs, developing into invasive breast cancer. This explains why it is also referred to as ‘pre-cancerous’.

Dr. Amish decides on the stage of malignancy and starts on the immediate course of treatment.

Symptoms of Malignant Breast Cancer

Here are some of the symptoms that may indicate malignant Breast Cancer:

Changes in how the breast or nipple feels

Tenderness or a lump or an unusual mass in the underarm area or near the breast or underarm area

Enlargement of pores in the skin of the breast (often resembling that of an orange peel) or a similar transformation in the texture of the skin

Changes in the appearance of breast or nipple

A sudden unexplained alternation in the shape or size of the breast

Sudden swelling of the breast

Dimpling or puckering on the breast

Nipple which is turned slightly inverted or inward

Unexplained shrinking of the breast, which usually is only on one side

Breasts suddenly become asymmetry in size

Skin of the breast or nipple turns red, scaly or swollen

Appearance of rashes on or around the nipple

Discharge from the nipple

For women who are not lactating, a whitish discharge from the nipple may be a symptom of malignant cancer.

As lumps in the breast is the major symptom for both benign and malignant cancers, awareness in women regarding the initial symptoms, followed by health check-ups and medical tests immediately is mandatory. Early detection of malignant tumours usually enhances the chances of cure. A monthly self-examination is a first step towards detecting an unexpected lump in the breast and consulting a doctor immediately. When tests indicate malignancy, the patient usually needs to approach a radiologist for chemotherapy and, if necessary, a Surgical Oncologist for further treatment. Doctor Amish Dalal recommends the surgery that may be well-suited for individual patients after a thorough examination of the patient’s medical tests.

The importance of being physically active cannot be emphasised enough. A regular exercise routine to prevent a sedentary lifestyle is applicable for everyone, irrespective of age, sex and other factors. An active lifestyle reduces the risk of diseases and cancer is no different. Physical exercise is believed to not only reduce the risk of cancer but also helps cancer patients recuperate after the necessary course of treatment has been completed. Dr. Amish V Dalal, an accomplished Surgical Oncologist, may suggest a specialist on request from his patients after a surgery to advise them on exercises for recuperation. The American Cancer Society recommends at least 150 minutes of weekly activity of moderate intensity for adults and 75 minutes of vigorous exercise.

Research studies by National Cancer Institute and the American Cancer Society reports that regular physical exercises can reduce the risk of 13 specific types of cancer. This comes as a wide contrast to popular studies that have found any links between cancer and physical activities to be inconclusive, with the exception of breast, colon and endometrial cancer. The American Cancer Society now associates physical activity to reduced risk of other types of cancers as well, like stomach cancer, liver cancer, oesophageal cancer, kidney cancer, myeloid leukaemia, blood cancer, multiple myeloma, as well of cancer of lungs, bladder, rectum, neck and head. While Dr. Amish Dalal recommends the necessary course of treatment, a regular exercise routine may help patients in receiving better outcomes.

Some recent studies also indicate that physical exercises may also result in shrinkage of cancer tumours. Researchers believe that the adrenaline rush that is the usual consequence of high-intensity exercises reduces the growth of cancerous tumours. They have concluded that the adrenaline plays an active role in circulating immune cells that are natural killers (NK) into the bloodstream. These natural killer immune cells infiltrate tumours that may be existent in certain specific body parts like the skin, liver and lungs. These immune cells are believed to eliminate cancerous cells. Apart from daily physical activities, a regular check-up with Doctor Amish Dalal, according to his advice, is essential for him to continue with the necessary line of treatment.

Physical activity after diagnosis of breast cancer may improve breast cancer outcomes by lowering the level of oestrogen in the body. Exercise may improve bowel movement, leading to reducing chances of contact with agents that cause cancer. Exercising may also reduce the production of insulin that may expedite the growth of cancerous tumours. After surgery by Amish Dalal, an experienced gynaecologist specialising in surgical oncology, patients may resume on their daily physical activity, based on the advice of medical practitioners.

A regular exercise routine that a cancer patient may follow depends on certain factors like age, ‘stage’ of cancer, existence of other health issues, amongst others. Here are a few recommendations of indoor and outdoor physical activities that cancer patients may opt for, depending on their age and area of interest:

Brisk or leisurely walking and jogging

Cycle; cycling at a comfortable speed

A sport like tennis, badminton or football

Yoga

Patients diagnosed with malignant tumours can book an appointment with Amish Dalal at Jaslok Hospital, Breach Candy Hospital, Bhatia General Hospital, Saifee Hospital or Parsee General Hospital.